Agencies with Medicare Intermediary CGS will need to update the Main office software to version 5699 released 03/12/15.  2015 Transitional CBSA Codes will be utilized for Medicare claims.  Software changes were made previously to accommodate the Intermediary’s use of 2015 CBSA Codes.  The Intermediary has now converted its systems for use of the 2015 Transitional CBSA Codes.  If your agency has received claim rejections due to the CBSA Code, please update the Main office software to version 5699 and recreate the claim for submission which will attach the 2015 Transitional CBSA Codes.  If an urgent Medicare claim is required for submission prior to the ability to update the Main office software, agencies may select the check box “Use Transitional CBSA on 2015 claims”.  The check box can be found in the PPS tab in the Insurance data base when the applicable Insurance record is displayed.  Claims may then be recreated and submitted.  The check box will no longer be required after updating to Main office software version 5699.

Available with the current software versions in both the Main office and Clinical Point of Care Software, an additional tab screen has been added to the 485 Plan of Care and Physician Order (Special Type Face to Face Encounter).  The new tab is labeled Home Health Eligibility for agencies wishing to provide documentation of a Clinical Summary for the Certifying Physician to incorporate into their medical record to assist in meeting documentation requirements for the Medicare 2015 Face to Face Encounters.  Documentation will print on the 485 Plan of care and Physician Order/Face to Face Encounter under a heading “Clinical Summary/Recertification need and Duration.  As defined by the heading Home Health Agencies may also use the Eligibility tab to include a Recertification summary identifying a patient’s continued need and anticipated duration of services.

Agencies utilizing the Clinical Point of Care software will also have available for use the ‘Import (CA) Narrative’ button found on the Home Health Eligibility screen.  Documentation by a Clinician of a Clinical Summary, 60 Day Summary, Recertification need and duration, entered in the Narrative screen in Comprehensive Start of Care, Recertification, and Resumption of Care used as a Recertification assessment can be Imported to the Home Health Eligibility screen without a need to re-key the documentation.  Import is completed by selecting the ‘Import (CA) Narrative’ button.  A secondary screen will display by date Start of Care, Recertification, and Resumption of Care Comprehensive OASIS Assessments.  Select/highlight the date and activity then select the Import button.  The Documentation specific to the Narrative field in the Narrative screen will populate the Home Health Eligibility tab.

The ‘PPS What If’ tool available for PPS Billable OASIS Assessments in the Main office software has been updated to reflect the changes for OASIS C1- ICD9 with Main Office software version 5693.

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